Non-invasive respiratory support

Question 1

Primary muscles & innervation of respiration

Answer 1

• accessory nerve (CN XI)
• Spinal nerve (intercostal n)
• Intercostal muscles
• Diaphragm
• Hypoglossal n (CNXII)
• Phrenic nerve

Question 2

Respiratory complications with spinal cord injury: cause of mortality

Answer 2

Due To:

• weak breathing ms
• inability to inspire fully
• inability to cough
• inability to clear secretions

Question 3

Respiratory complications with spinal cord injury: increase risk for

Answer 3

• secretion retention/atelectasis
• mucus plugging and infection
• respiratory failure

Question 4

Significance of cough

Answer 4

Primary cause of pulmonary infection in is the inability to cough effectively and clear secretions

Question 5

Cough: PCF to move secretions

Answer 5

160 - 200 L/min.

Question 6

Inadequate cough: cause

Answer 6

Reduced lung volumes and weak abdominal muscles result in an inadequate cough.

Question 7

LV recruitment: when do we use it?

Answer 7

• Patient with weakness
• Patient with spinal cord weakness
• ALS (inspiratory weakness, poor cough)

20-30 minutes before a meal: offers increased airway protection, promotes airway clearance and increases protection

• We don’t use for patients with COPD.

Question 8

LV recruitment: goals

Answer 8

Increase lung volume
Improve cough effectiveness
Decrease atelectasis
Increase mechanical compliance
Optimize thoracic range of motion
Increase speaking volume

• Purpose is the same as PEP device (get air into air spaces behind the secretions).

Question 9

LV recruitment: when to use? dosage

Answer 9

• 4 treatments per day
• 1 treatment = 3 to 5 maximum insufflations
• Best before meals and at bedtime
• Combine with assisted cough 2 times per day or PRN if secretions present
• Avoid hyperventilation: no more often than every 10 minutes
• Change interface if air escapes around mouth

Question 10

LVR: cautions

Answer 10

1. Remove unidirectional flap from the one way valve closest to the client (prevents dislodging of valve into airway)
2. Not to be used for resuscitation. If used for resuscitation, a tension pneumothorax may occur
3. Should not induce dizziness or chest discomfort
4. Maintain eye contact

Question 11

LVR: Patient positioning

Answer 11

• Best in sitting

- Can be done supine or semi-fowlers

Question 12

Assisted cough: techniques

Answer 12

• Caregiver-assisted abdominal thrust
• Caregiver-assisted lateral costal compression
• Client self-assisted cough

Question 13

Assisted cough: hand placement

Answer 13

Landmark naval and place heel of one hand on abdomen just above navel

Question 14

Assisted cough: contraindications

Answer 14

• Pregnancy
• Abdominal aneurysm
• Rx Abd surgery
• PEG tube
• Acute upper GI breed
• Cognitive deficits

Question 15

LVR with MI-E

Answer 15

The MI-E is introduced if other volume recruitment techniques fail to achieve a peak cough flow (PCF) > 270L/m
(e.g. cold, pneumonia)

Question 16

Risk of organ damage?

Answer 16

Low muscle tone the organs will move out of the way (patient won’t tense up)

Question 17

Modes of Ventilation

Answer 17

Delivery of pressure:
1. invasive = positive = endotracheal intubation

2. non-invasive = negative (iron lung) or positive (CPAP, IPPB, BiPAP)

Question 18

CPAP

Answer 18

continues positive airway pressure
- used with in obstructive sleep apnea to splint open and obstructed airway. Adjustment time required to become accustomed to exhale against a constant pressure

Question 19

BiPAP

Answer 19

Bilevel Positive Airway Pressure
- more comfortable
- takes away additional work, used only at night
- inspiratory and expiratory airway pressure
(keeps alveoli open increasing functional residual capacity)

Question 20

Choice of Interface

Answer 20

1. Nasal- most comfortable but cannot be used with mouth leaks. Skin breakdown can occur.
2. Oral- less skin breakdown, not most comfortable.
3. Full face- best for mouth leaks but can be claustrophobic. Skin breakdown can occur.
4. Total face mask- less skin breakdown but can be claustrophobic, less comfortable